Collective Iranian Culturebase

* Health care in Iran *

بهداشت درمان درایران

Healthcare in Iran is based on three pillars: the public-governmental system, the private sector, and NGOs. The healthcare and medical sector''s market value in Iran was almost US $24 billion in 2002 and was forecast to rise to US $31 billion by 2007. With a population of 75 million (2012), Iran is one of the most populous countries in the Middle East. The country faces the common problem of other young demographic nations in the region, which is keeping pace with growth of an already huge demand for various public services. The young population will soon be old enough to start new families, which will boost the population growth rate and subsequently the need for public health infrastructures and services. Total healthcare spending is expected to rise from $24.3 billion in 2008, to $50 billion by 2013, reflecting the increasing demand on medical services. Total health spending was equivalent to 4.2% of GDP in Iran in 2005. 73% of all Iranians have health care coverage. Iran is also the only country with a legal organ trade.

According to the World Health Organization (WHO), as of 2000, Iran ranks 58 in health care and 93 in health-system performance. in 2013, Bloomberg ranked Iran 45th Most efficient Health Care System ahead of United States and Brazil. The report shows Life Expectancy in Iran is 73 years and $346 Per capita spending on healthcare. The health status of Iranians has improved over the last two decades. Iran has been able to extend public health preventive services through the establishment of an extensive Primary Health Care Network. As a result child and maternal mortality rates have fallen significantly, and life expectancy at birth has risen remarkably. Infant (IMR) and under-five (U5MR) mortality have decreased to 28.6 and 35.6 per 1,000 live births respectively in 2000, compared to an IMR of 122 per 1,000 and a U5MR of 191 per 1,000 in 1970. Immunization of children is accessible to most of the urban and rural population.

Health services See also: Ministry of Health and Medical Education and Demography of IranDemography of Iran - population pyramid

IRAN: Healthcare (Source: EIU) 2005 2006 2007 2008 2009 2010

Life expectancy, average (years)

70.0

70.3

70.6

70.9

71.1

71.4

Healthcare spending (% of GDP)

4.2

4.2

4.2

4.2

4.2

4.2

Healthcare spending ($ per head)

113

132

150

191

223

261

Coverage See also: Social Security Organization (Iran)

The constitution entitles Iranians to basic health care, and most receive subsidized prescription drugs and vaccination programs. An extensive network of public clinics offers basic care at low cost, and general and specialty hospitals operated by the Ministry of Health and Medical Education (MOHME) provide higher levels of care. In most large cities, well-to-do persons use private clinics and hospitals that charge high fees. About 73% of all Iranian workers have health care and social security coverage. In 2000, 94% of the population could access local health services, according to the WHO. Access ranged from 86% in rural areas to 100% in urban areas. Between 80% and 94% of the population could access affordable essential medicines in 1999. Since 2009, a new government plan called "the comprehensive insurance plan" provides basic coverage to all Iranians.

Workforce See also: Education in IranDental care facility in Iran

Iran has been very successful in training/educating the necessary human resources for its health system. The system of almost 30 years ago where the country was facing a shortage of all kinds of skilled personnel in the health and medical sector has been completely changed into one in which the necessary professionals now completely suffice the country’s needs. There are now 488 government funded hospitals in Iran. There were 0.5-1.1 physicians per 1000 population in 2004 according to various estimates (about 46 percent of physicians were women).

Health network See also: List of hospitals in IranShariati Hospital in Tehran

Today the largest healthcare delivery network is owned and run by the Ministry of Health and Medical Education (MOHME) through its network of health establishments and medical schools in the country. MOHME is in charge of provision of healthcare services through its network, medical insurance, medical education, supervision and regulation of the healthcare system in the country, policymaking, production and distribution of pharmaceuticals, and research and development. Additionally, there are other parallel organisations such as Medical Services Insurance Organizations (MSIO) that have been established to act as a relief foundation as well as an insurance firm. Some hospitals, such as Mahak for children''s cancer, are run by charitable foundations.

According to the last census that Statistical Centre of Iran undertook in 2003, Iran possesses 730 medical establishments (e.g. hospitals, clinics) with a total of 110,797 beds, of which 488 (77,300 beds) are directly affiliated and run by the MOHME and 120 (11,301 beds) owned by the private sector and the rest belong to other organisations, such as the Social Security Organization of Iran (SSO). There were about seven nurses and 17 hospital beds per 10,000 population.

An elaborate system of health network has been established which has ensured provision of Primary Health Care (PHC) to the vast majority of public. However, access and availability of health care continues to be somewhat limited in lesser developed provinces where the health indices are also lower as compared to national averages. The country is in an epidemiologic transition and faces double burden of the diseases. New emerging threats should also be considered. The demographic and epidemiological transition underway will have a significant effect on the pattern of morbidity and mortality in the near and distance future, especially as it affects the emergence of chronic non-communicable diseases and the health problems of an aging population.

Although overall improvements have been achieved in all health areas since the 1979 revolution, the present challenging economic conditions of the country, combined with rapid advances in medical technology and information technology, individuals’ expectations, and the young demographic of the population will undoubtedly challenge the sustainability of past improving trends.

Iran has one of the highest percentages of population in the Middle East with access to safe drinking water, with an estimated 92% of its people enjoying such access (nearly 100% in urban areas and about 80% in rural areas as of 2007).

There is a considerable shortfall in wastewater treatment; for example, in Tehran the majority of the population has no wastewater treatment, with raw sewage being injected directly into the groundwater. As the water crisis deepens with an expanding population, this pollution of groundwater causes increasing health risks.

Nutrition See also: Agriculture in Iran, Cuisine of Iran, Sport in Iran, List of countries by percentage of population suffering from undernourishment and Codex AlimentariusPercentage of national population suffering from malnutrition, according to United Nations statistics.

As an additional measure of public health and inefficient food distribution, about thirteen percent of the young people are classified as obese, according to the same United NationsFAO sources. According to the government of Iran, about 60 percent of Iranians are overweight and 35 percent of women and 15 percent of men suffer from obesity in Iran. Forty-five million Iranians face inadequate nutrition according to Iranian officials. Kohgiloyeh and Boyerahmad, Sistan-Baluchistan, Hormozgan, Kerman and Khuzestan as provinces that face malnutrition or food insecurity.

The Codex Commission of Food Stuff, established in 2002 is in charge of setting and developing standards and quality and health regulations, related to the production of and trade in raw agricultural products and food stuffs, in accordance with the different global standards. Tainted meat has been imported according to Iranian authorities.

The soft drinks industry is valued at about $2 billion a year. Today, Iran produces about 3 billion litres of different types of soft drinks to address consumption of 46 litres per capita, and exports more than 12% of its production. Increased awareness with regards to the damages of carbonated drinks and sugar, and high levels of diabetes has created a move towards healthier products. 30% of Iranian youths never play any sports.

Communicable diseases & addictions

Immunization of children is accessible to most of the urban and rural population.

Cholera

Cholera has been a persistent problem in Iran. In the 2005 epidemic which involved loss of lives, state television warned people not to eat vegetables or buy ice blocks on the streets. Salads were also banned in some restaurants. The 1998 epidemic involved considerably more cases and loss of life.

Increased drug use has driven up the incidence of human immunodeficiency virus (HIV). In 2005 two-thirds of the official total of 9,800 HIV cases were attributed to drug use. Iran has established a national HIV treatment system, including 150 testing sites and a free needle exchange program.

According to the United Nations, AIDS has been increasing in Iran at a rapid rate. The major factor fuelling the epidemic until now has been injecting drug use, while there is an increase in sexual transmission of the disease. An estimated 14% of people who inject drugs countrywide were living with HIV in 2007. In 2009, men account for 93 percent of the HIV patients, and women comprise 7 percent of the infected population.

The rate of the epidemic in Iran is however still very low compared to international standards. Iran has a low prevalence of HIV infections with a rate of about 0.16 percent of the adult population (18,000 cases, officially) compared with 0.8 percent in North America (2008). But according to the WHO, as of the end of 2009, there are more than 100,000 AIDS sufferers in Iran (approximately 0.135% of the Iranian population).

Drug addiction constitutes a major health problem. Iran is situated along one of the main trafficking routes for cannabis, heroin, opium and morphine produced in Afghanistan, and designer drugs have also found their way into the local market in recent years. Iran ranks first worldwide in the prevalence of opiate addiction with 2.8% of its population addicted. Initiation age for most Iranian addicts is their 20s. Hundreds of drug production laboratories have been set up in Pakistan and Afghanistan. Iran''s police said in April 2009 that 7,700 tonnes of opium was produced in Afghanistan in 2008, of which 3000 tonnes entered Iran, adding that the force had managed to seize 1000 tonnes of the smuggled opium. Iran spent over 600 million dollars in just the last two years to dig canals, build barriers and install barbed wire to seal off the country’s crime-infested borders.

Iran discovers 3 tons of drugs daily. In 2005, estimates of the number of drug addicts ranged from 2 to 4 million (1.2 million according to the Government). Reasons for addiction include lack of economic prospects among the youth and lack of freedom. In a 2014-survey, 30.6% of the youth considered financial issues as their biggest concern, while 28.9% chose unemployment, 10.8% university acceptance, and 7.5% marriage issues as their biggest worries.

Smoking Main article: Smoking in Iran See also: Smuggling in Iran

Iran has implemented a strict smoking ban in all public places (2007). According to the new law, smoking is prohibited in all public organizations, hotels, restaurants, tea houses and coffee shops. Also forbidden is the offering and smoking of ghalyun, the traditional Persian waterpipe, which is a must in Iranian tea houses. A smoking ban for all car drivers nationwide was implemented since March 2006, and although offenders could face fines, the ban was widely ignored by the drivers. Also selling tobacco products to anyone under 18 would result in confiscation of the vendor''s tobacco products and a cash fine. Repeated violations would lead to high cash fines.

About 20% of adult male and 4.5% of adult female population in the country smoke tobacco (12 million smokers according to some estimates). 60,000 Iranians die directly or indirectly due to smoking every year (2008). Smoking is responsible for 25% of death in the country. Approx. 54bn-60bn cigarettes are believed to be consumed annually in Iran. Around 2.7bn cigarettes are smuggled into Iran annually, according to officials from the state-owned Iranian Tobacco Company (ITC), on top of another 26.7bn which are imported legally (2008). Imports of cigarettes, tobacco, cigars, cigarette paper, cigarette tips are subject to government monopoly. Iranians spend more than $1.8 billion a year on tobacco. According to a 2010-law, smokers henceforth will not be appointed to senior government jobs.

The prevalence of respiratory diseases and cancers in Iran is increasing at a significant rate, also because of air pollution in Tehran. It is estimated that 5 million Iranian children suffer from asthma. The World Bank estimates losses inflicted on Iran’s economy as a result of deaths caused by air pollution at $640 million, which is equal to 5.1 trillion rials or 0.57 percent of GDP. Substandard gasoline and imported car brakes are also a reported health hazard/air pollutant according to the authorities.

Prohibited in Iran because of the Islamic law, except for non-Muslims who can legally consume alcoholic beverages in private. Alcohol smuggling into Iran was estimated at nearly $1 billion in 2010. More than 200,000 people in Iran are estimated to be involved in bootlegging. Many rely on what''s made in people''s basements or gardens in unsanitary conditions.

The Islamic Republic of Iran has a comprehensive and effective program of family planning. While Iran''s population grew at a rate of more than 3% per year between 1956 and 1986, the growth rate began to decline in the late 1980s and early 1990s after the government initiated a major population control program. By 2007 the growth rate had declined to 0.7 percent per year, with a birth rate of 17 per 1,000 persons and a death rate of 6 per 1,000. Reports by the UN show birth control policies in Iran to be effective with the country topping the list of greatest fertility decreases. UN''s Population Division of the Department of Economic and Social Affairs says that between 1975 and 1980, the total fertility number was 6.5. The projected level for Iran''s 2005 to 2010 birth rate is fewer than two. As at 2012, more than half of Iran''s population is under 35 years old. Authorities are now slashing its birth-control programs in an attempt to avoid an aging demographic similar to many Western countries that are struggling to keep up with state medical and social security costs.

Leading causes of mortality See also: Road accidents in Iran and Preventive medicine

In the early 2000s the main natural causes of death have been cardiovascular disease and cancer. Cancer Research Center of Iran says 41,000 Iranians die of cancer each year.

According to Ministry of Health and Medical Education, in 2003, 41% of total deaths were due to diseases of the circulatory system. Myocardial infarction as the cause of 25% of deaths was the leading cause of mortality among the population.

Addiction is the fourth major cause of death in Iran following road accidents, heart disease and depression.

From 2001 to 2010, over 438,000 Iranians have died from "unnatural deaths" such as electric shocks, gas poisoning, and drug intoxication. 4,055 people committed suicide in in 2013 and the number of suicides is on the rise. The Association of Social Workers of Iran released in 2013 indicating 61,000 people committed suicide in Iran from 2001 to 2011.

Pharmaceuticals See also: Iranian National Formulary

The pharmaceutical industry in Iran began in its modern form in 1920 when the Pasteur Institute of Iran was founded. Iran has a well-developed pharmaceutical production capability, however, the country still relies on imports for raw materials and many specialized drugs. The standards regarding pharmaceutical products in Iran are determined and modified by the Pharmacopeia Council.

Iran’s Ministry of Health and Medical Education (MOHME) has a mission to provide access to sufficient quantities of safe, effective and high quality medicines that are affordable for the entire population. Since the 1979 revolution, Iran has adopted a full generic-based National Drug Policy (NDP), with local production of essential drugs and vaccines as one of the main goals.

Although over 85 percent of the population use an insurance system to reimburse their drug expenses, the government heavily subsidizes pharmaceutical production/importation in order to increase affordability of medicines, which tends also to increase overconsumption, overprescription and misuse of drugs, much like the abuse of pharmaceutical opioids in Iran such as the heavily prescribed codeine for moderate to severe pain. The regulatory environment of the country is rather strict on the import of drugs and pharmaceuticals towards companies that intend to enter into the market for the first time. The Ministry of Health and Medical Education is the main stakeholder of pharmaceutical affairs in the country.

The drug market in Iran is heavily in favour of generic medicines, which contributed US$1.23bn to the total in 2009, with patented drugs at US$817mn and OTC medicines at US$262mn.

The market share of local production (value-wise) has declined from 85.2% to 63.4% over the past 8 (Iranian) years (2009). In this period the value of importation has jumped from 14.8% to 36.6%. The government imposes 90% tariff on the import of drugs. In 2009, 1.8 million units of pharmaceutical products worth $1.2 billion were imported into Iran.

Iran has produced a wide range of pharmaceuticals drugs for the treatment of cancer, diabetes, infection and depression.

The Islamic Republic of Iran is the first country in the East Mediterranean region which has the technical and scientific capability to export vaccines to various world countries. Iran will gain self-sufficiency in vaccine production by 2014.

The new drugs launched in Iran for the treatment of MS include an interferon beta-1b by CinnaGen. Gamma Immunex (recombinant interferon beta 1), Pegaferon (recombinant pegylated interferon (PEG-IFN)) and regenerative human factor VIII are among other recombinant-based medication made in Iran. A generic version of fingolimod by Novartis has been launched as well as a biosimilar version of EMD Serono′s Rebif.

Iranian researchers have developed 41 types of anti-cancer medications, overcoming the need for importing pricey cancer drugs from abroad (2011). There are also 24 additional biosimilar drugs which Iran plans to bring into production by end of 2012. Iran plans to become self-sufficient in biotech medicines production within 4 years.

According to the Food and Drug Administration in 2014, drugs for sexual enhancement, weight control, aesthetics, height enhancement, hair growth and body building are among the more prevalent fake drugs on the market. Trade in counterfeit commercial drugs, most of which come from Pakistan, has become more lucrative than dealing in illegal narcotics.

In recent years several drugmakers are gradually developing the ability to innovate, away from generic drugs production itself. Iran has around 8000 species of plant life and researches indicate that more than 2300 species have remedial characteristics or can be used as cosmetic products; only 100-300 of which are being used in pharmaceutical industries at present. Iran has 80 percent of the world medicinal herbs. Due to lack of required technology, they are exported raw and in limited quantities to foreign markets.

There are 92 companies in Iran that are active in the pharmaceutical industry. The Social Security Investment Co. (SSIC), Iran''s largest holding company, which is affiliated to the Ministry of Welfare, presently owns and controls 22 pharmaceutical manufacturing companies and possesses a 40% share of total pharmaceutical production in Iran.

The leading pharmaceuticals company is Darou Pakhsh, which is majority-owned by the Social Security Organization. The company manufactures, distributes, imports and exports finished products and pharmaceutical raw materials. Darou Pakhsh has an annual turnover of US$400m and claims to have the largest research and development operation of any Iranian drug firm. The company formed a plasmapheresis joint venture with a German medical firm, Biotest AG, in early 2004. As of 2010, 50% of raw materials and chemicals used in the drug manufacturing sector are imported. Iranian pharmaceutical manufacturers are also disadvantaged by the government′s poor intellectual property protection regime and because of lack of foreign direct investment.

The Department of Medical Equipments in the Ministry of Health and Medical Education (MOHME) is responsible for supervising imports in this segment, but the import and distribution of such equipment is mostly handled by the private sector. Iran has undergone the primary stages of development in terms of industrialisation and a rather strong indigenous manufacturing capability exists in the country. Therefore one can expect to find a handful of local producers for basic medical equipment, making it very hard to penetrate into the Iranian market for similar imported ones.

Iran MED and Iran LAB are the main annual exhibitions relating to medical and laboratory equipment in Tehran. In 2009, approximately $3.1 billion worth of drugs and medical products were consumed in Iran. This shows an 80% increase from 3 years ago. Iran’s per capita consumption is $21, as opposed to the global average of $94 because Iran subsidizes heavily its medical and pharmaceutical industry. In 2009, Iran exported $74 million worth of "medical products" to countries such as Iraq, Afghanistan and Russia.

U.S. sanctions against Iran do not apply to medical equipment or pharmaceuticals. There are over 100 Iranian companies representing the international suppliers in this market, handling both promotion and the after-sales service of the products. Iran is a mature market when it comes to medical equipment. Most of the major international players in this sector are present in the Iran market: